Reproductive Health - Vulvar Disorders and Vulvar/Vaginal
Neoplasms exam
1. Who is lichen sclerosus MC in?: MC in prepubertal and peri/postmenopausal period
2. What is the cause of lichen sclerosus?: - genetic, immunologic, hormonal (low-estrogen),
infection, and cell kinetics
3. What are symptoms of lichen sclerosus?: Usually in anogenital region
- Pruritus (often interferes with sleep)
- Anal discomfort
- Dyspareunia
- Dysuria
- may also be asymptomatic
4. What appears on PE of lichen sclerosus?: - thin, white, atrophic papules and macules that may
coaelesce into plaques
- excoriations due to scratching
- loss of vulvar architecture (can not distinguish between labia majora and minora)
5. What can lichen sclerosus progress to?: Squamous cell carcinoma, although low risk
,6. Where does lichen sclerosus usually occur?: MC in labia minora and/or labia majora
- may extend to clitoris, perineum, and around anus in a KEYHOLE/FIGURE 8 fashion
7. How is lichen sclerosus diagnosed?: Clinical diagnosis, but punch biopsy can be done PRE-treat-
ment to assess for malignancy
8. What are indications for a biopsy for lichen sclerosus?: - uncertain diagnosis
- treatment fails
- assess for concomitant malignancy
9. What appears on biopsy of lichen sclerosus?: - Thinned epidermis
- areas of hyperkeratosis
- early lesions with mild acanthosis
10. Should asymptomatic patients with lichen sclerosus be treated?: YES
11. How is lichen sclerosus treated?: 1. Clobetasol propionate 0.05% ointment ONCE nightly x 12
weeks
2. After 12 weeks, maintenance topical corticosteroid ointment 2-3 nights/week
3. IF thickened, hypertrophic plaques -> triamcinolone may be needed
4. IF refractory:
- oral acitretin and methotrexate
, - phototherapy
- laser therapy
12. What is a good response to lichen sclerosus treatment?: - Relief of pruritus and pain
- Resolution of hyperkeratosis
- fissuring
- ecchymoses
13. What occurs with lichen simplex chronicus?: - Reactive skin pattern with thick, indurated skin
secondary to chronic, habitual rubbing/scratching
14. What is lichen complex chronicus caused by?: - atopic dermatitis
- psoriasis
- contact dermatitis
- chronically scratched vulvar lichen sclerosus
15. What are symptoms of lichen simplex chronicus?: - Vigorous scratching and rubbing
- exacerbated by heat, humidity, sweating, and at night
- anxiety and depression due to itch/scratch cycle
16. What are PE findings of lichen simplex chronicus?: - THICKENED, red epidermis
- thick and LEATHERY skin with increase in skin markings (lichenification)
Neoplasms exam
1. Who is lichen sclerosus MC in?: MC in prepubertal and peri/postmenopausal period
2. What is the cause of lichen sclerosus?: - genetic, immunologic, hormonal (low-estrogen),
infection, and cell kinetics
3. What are symptoms of lichen sclerosus?: Usually in anogenital region
- Pruritus (often interferes with sleep)
- Anal discomfort
- Dyspareunia
- Dysuria
- may also be asymptomatic
4. What appears on PE of lichen sclerosus?: - thin, white, atrophic papules and macules that may
coaelesce into plaques
- excoriations due to scratching
- loss of vulvar architecture (can not distinguish between labia majora and minora)
5. What can lichen sclerosus progress to?: Squamous cell carcinoma, although low risk
,6. Where does lichen sclerosus usually occur?: MC in labia minora and/or labia majora
- may extend to clitoris, perineum, and around anus in a KEYHOLE/FIGURE 8 fashion
7. How is lichen sclerosus diagnosed?: Clinical diagnosis, but punch biopsy can be done PRE-treat-
ment to assess for malignancy
8. What are indications for a biopsy for lichen sclerosus?: - uncertain diagnosis
- treatment fails
- assess for concomitant malignancy
9. What appears on biopsy of lichen sclerosus?: - Thinned epidermis
- areas of hyperkeratosis
- early lesions with mild acanthosis
10. Should asymptomatic patients with lichen sclerosus be treated?: YES
11. How is lichen sclerosus treated?: 1. Clobetasol propionate 0.05% ointment ONCE nightly x 12
weeks
2. After 12 weeks, maintenance topical corticosteroid ointment 2-3 nights/week
3. IF thickened, hypertrophic plaques -> triamcinolone may be needed
4. IF refractory:
- oral acitretin and methotrexate
, - phototherapy
- laser therapy
12. What is a good response to lichen sclerosus treatment?: - Relief of pruritus and pain
- Resolution of hyperkeratosis
- fissuring
- ecchymoses
13. What occurs with lichen simplex chronicus?: - Reactive skin pattern with thick, indurated skin
secondary to chronic, habitual rubbing/scratching
14. What is lichen complex chronicus caused by?: - atopic dermatitis
- psoriasis
- contact dermatitis
- chronically scratched vulvar lichen sclerosus
15. What are symptoms of lichen simplex chronicus?: - Vigorous scratching and rubbing
- exacerbated by heat, humidity, sweating, and at night
- anxiety and depression due to itch/scratch cycle
16. What are PE findings of lichen simplex chronicus?: - THICKENED, red epidermis
- thick and LEATHERY skin with increase in skin markings (lichenification)
